Keeping Developmental Center (DC) Closures on Track Is Crucial Given Increasing Reliance on General Fund and Federal Funding Risks. The state plans to close its three remaining DCs by the end of 2021. As DC populations decline, there are fewer federally reimbursable services provided. There is also an ongoing risk of losing federal funding for the DCs due to noncompliance with health and safety regulations. Given the resulting, and increasing, reliance on the state’s General Fund, it is crucial DDS keeps DC closures on track.

Trailer Bill Changes Intent of Community Placement Plan (CPP) Funding. A proposed trailer bill would broaden the use of CPP funding (which was intentionally designed by the Legislature to serve those moving from DCs), allowing resource development for consumers who already live in the community. We believe funding decisions regarding the development of resources for consumers already living in the community should be considered separately from CPP funding decisions and should be based on a needs assessment that supports a funding request. The Legislature may also wish to weigh in on whether any excess CPP funding should revert to the General Fund or remain with DDS for other purposes.

DDS Falling Behind in Helping Providers Comply With New Federal Rule, Risking Potential Loss of Significant Federal Funding in Future Years. DDS will receive about $2 billion in federal funding in 2017-18 through Home- and Community-Based Services (HCBS) Medicaid waivers. A new federal rule requires states (and service providers) to modify their HCBS programs by 2019 or risk losing some or all HCBS funding. We find that DDS has provided relatively little guidance to the state’s service providers on how to reach compliance and recommend the Legislature require DDS to report during budget hearings on what it knows thus far about the extent of noncompliance with the new federal rule and on what additional resources may be needed to facilitate timely compliance.

Rate Study Should Evaluate Rate-Setting Processes That Adapt to Changes in Policies and Economic Conditions. Last year, the Legislature provided $3 million to DDS for a contractor to conduct a study to examine current provider rate-setting methods and to provide recommendations to restructure rates. We recommend the Legislature make known its preference to include consideration of economic conditions and changes in policy as the contractor develops a “rate maintenance process.”

Complicated Rollout of Service Provider Rate Increases May Warrant Relaxed Reporting Requirements. Last year, the Legislature targeted $169.5 million in funding for rate increases to service provider staff who spend at least 75 percent of their time providing direct care to consumers. Although it made sense to target resources to direct care, associated administrative work has been time-consuming and some providers may risk forfeiting their rate increases. We have recommendations for the Legislature that would ease reporting and enforcement related to these rate increases.